Have you ever experienced leakage of urine when exercising, laughing, coughing, sneezing?

Never

Sometimes

Often

Occasionally

Yes, Regularly

Have you ever struggled with Severe Constipation?

Never

Sometimes

Often

Occasionally

Yes, Regularly

Have you (in the past 3 months) or do you experience pain with penetration or intimacy?

Never

Sometimes

Often

Occasionally

Yes, Regularly

Have you ever been pregnant or given birth?

Yes

No

Do you ever have to rush to the bathroom to pee or poop, and have trouble holding it?

Never

Sometimes

Often

Occasionally

Yes, Regularly

Do you experience pressure or heaviness in your vagina throughout the day or at the end of your day?

Never

Sometimes

Often

Occasionally

Yes, Regularly

Do you experience low back or hip pain that has not improved with other attempts to make it better?

Never

Sometimes

Often

Occasionally

Yes, Regularly

Are you limited from exercising the way you want due to anything having to do with "down there"?

Never

Sometimes

Often

Occasionally

Yes, Regularly

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